TITLE PAGE
Title: An effectiveness between first response team and basic life support team for stop bleeding on road traffic accident patients
Authors: Prat Intarasaksit
Affiliations:
Faculty of Public Health, Khon Kaen University, Thailand
Corresponding authors:
Name: Prat Intarasaksit
Address: , Faculty of Public Health, Khon Kaen University, Khon Kaen, 40002, Thailand
Telephone: +66-89-5855779
Fax: +66-xxxxxxxxx
e-Mail:
Type of contribution: Original research results
Running title: Effectiveness of first response team and basic life support
Number of words in the abstract: 406
Number of words in the text: 2,779
Number of tables: 3
Number of figures: 1
1
ABSTRACT
Background: Road traffic accident is one of highest cause of mortality in Thailand. Emergency Medical System (EMS) is the main unit for preserve victims from emergency accidents. First response team (FR) and Basic life support team (BLS) is two of three team in Thailand EMS. Different of two teams is officer in FR team is responder who was pass basic for first aid training at least 24 hour, but officer in BLS team is who had more than hour training than FR team, therefore scope of trauma management was different, but only one trauma management just same between two teams it is stop bleeding. It never has reported from effectiveness between first response team and basic life support in stop bleeding case.
Objective: To compare an effectiveness between first response team and basic life support team for stop bleeding case in road traffic accident patients in Thailand
Methods: This study designs is retrospective analytical and collect data from Thai Emergency Medical Service database. All case of road traffic accident in this study will conduct from January 2011 to December 2012. Multiple logistic regression was use to quantify and test effectiveness for stop bleeding between first response team and basic life support team and present by Odds Ratio (OR), 95% Confidence Interval (95%CI), and p-value.
Results: Since January 2011- December 2012 all of emergency case who call to emergency medical system were collect x,xxx,xxx cases, and xxx,xxx case (xx.x%) was road traffic accident. For case preserve by FR team is xxx,xxx cases (xx.xx % OR x.xx, 95% CI x.xx to x.xx; p=x.xxx), preserve by BLS team is xxx,xxx cases (xx.xx % OR x.xx, 95% CI x.xx to x.xx; p=x.xxx) For FR team there were male xxx,xxx (xx.x) and female xxx,xxx (xx.x%) and male xxx,xxx (xx.x) and female xxx,xxx (xx.x%) for BLS team. BLS team had effectiveness than FR team for stop bleeding case on road traffic accident (OR x.xx, 95% CI x.xx to x.xx)
Conclusions: Basic life support team has effectiveness than first response team because BLS team has officer who has more training hour than FR team. But not best, because either data was show inappropriate stop bleeding case. Therefore, should be increased program training of both team for improve trauma management skill. Further, researcher should determine effectiveness on other trauma management in patients from same case or other case.
Key words: first response, basic life support, emergency medical system, road traffic accident, stop bleeding
INTRODUCTION
Road traffic accident related injuries are top causes of injuries worldwide especially low and middle-income countries and will increasing every year (1)(2) (3).Therefore, emergency medical systems (EMS) are able to reduce the mortality and morbidity of injuries by prompt provision of essential life-saving measures such as maintenance of patent airway and controlling external bleeding of a trauma patient(1)(4)(5). In all, 90% of deaths from injury occur at the scene or en route to a healthcare facility.
According to the World Health Organization for the year 2012 indicates that mortality rate from traffic accidents in Thailand is 6th of the world's 42.9 per 100,000. Thai Road Safety Culture (Thai RSC) has reported in BE.2556 Thailand has patients from road traffic accident are 246,398 injuries and fatalities 3,442 (6) (7).
Thailand has adopted the Anglo-American model providing Emergency Medical System (EMS) through hospital service which incorporated into the health care system in 1994(8). The initial of EMS is start by patient or witness who calls to dispatch center, and dispatch center make a decision to send appropriate team to accidence scene. Treatment or first aid care is given to patient at accidence scene and during transfer patient to hospital.
First response team (FR) and Basic life support team (BLS) is two of three team in Thailand EMS. Different of two teams is officer in FR team is responder who was pass basic for first aid training at least 24 hour, but officer in BLS team had more hour training than FR team.
Therefore, scope of trauma management was different such as basic airway management for first response team, but advance in basic life support team. But only one of trauma management not different it is stop bleeding. It never has reported from effectiveness between first response team and basic life support in stop bleeding case.
Traumatic injuries and medical emergencies can be managed appropriately and skillfully by ambulance technicians and medical staff who have trained in prehospital course(5) (9). An effective emergency medical service system which could save lives of those who got injured from accidents or critical illness requited an assessment and rapid and appropriate care for each individuals(10) (11). But never has reported about the effectiveness for stop bleeding from road traffic accident cases carried by First response team and basic life support in Thailand. This study aim to compare the effectiveness between first response team and basic life support for stop bleeding on road traffic accident patients in Thailand
MATERIALS AND METHODS
Study design A retrospective design was performed. Data in this study was used from Thai Emergency Medical System database, and it from all province of Thailand, but except Bangkok. Emergency Medical System database was collected since 2011 – 2012 from case report form (CRF). The database contain more a millions dataset. The dataset contain information of patients and accidence time, response time, type of trauma and trauma management etc.
In this study was used total of x,xxx,xxx case from road traffic accident case and excluded other accident event. The ethical issues will be approved by the committees of The Ethics and Research Institutional Review Board of Khon Kean University.
Study outcome
The main outcome was evaluated the effectiveness of fist response team for trauma management in road traffic accident case in Thailand. The effectiveness of this study is from checklist by medical staff at emergency room (ER). When first response teams at scene and treat patients such as bone stabilization, airway management or stop bleeding, and after that first response team transfer patients to hospital medical staff just check about appropriate of first aid in case report form.
Statistical analysis
· Methods for describing baseline characteristics of the sample: Demographic characteristics of the participants were described using frequency and percentage for categorical data and mean and standard deviation for continuous data.
· The logistic regression was used to identify the association variables, the statistics including Odds Ratios, 95% Confidence Intervals, and p-value All analyses were performed using Stata version 12.0 (StataCorp, College Station, TX). This project was approved by the Human Research and Ethics Committees of the Ministry of Public Health of Thailand.
RESULTS
A total of EMS cases for this study is x, xxx, xxx and there are road traffic accident cases is xxx,xxx cases (xx.xx%) and were treat by first response team is xxx,xxx (xx.xx%) and basic life support is xxx,xxx (xx.xx%) (Fig1).
Fig. 1 The consort diagram of this study
Demographic Characteristics
Altogether xxx,xxx were enrolled in the study. Of these xx,xxx (xx.x%) were excluded if first and second step because some of data was missing or trauma management by other team, this left xxx,xxx patients for analysis. The age of patients was seven grouping Xxx,xxx were male, and xxx,xxx female in first response team and xxx,xxx male xxx,xxx female in basic life support team. Stop bleeding from road traffic accident is xxx,xxx (xx.xx%) for first response team, and xxx,xxx (xx.xx%) for basic life support team. (table 1)
Table 1: Baseline characteristics of road traffic accident case from First Response team
Characteristic / Number (n) / Percent (%)First response’s cases from 2011 to 2012
Road Traffic Accidence case / x,xxx,xxx / xx.xx
Other case / x,xxx,xxx / xx.xx
Total / x,xxx,xxx / 100%
Basic life support’s case from 2011 to 2012
Road Traffic Accidence case / x,xxx,xxx / xx.xx
Other case / x,xxx,xxx / xx.xx
Total / x,xxx,xxx / 100%
First response team: Road traffic accidence age (year)
≤15 / x,xxx,xxx / xx.xx
16 - 25 / x,xxx,xxx / xx.xx
26 - 35 / x,xxx,xxx / xx.xx
36 - 45 / x,xxx,xxx / xx.xx
46 - 55 / x,xxx,xxx / xx.xx
>56 / x,xxx,xxx / xx.xx
Mean (SD) / xx.x (±x)
Total / x,xxx,xxx / 100%
Basic life support team: Road traffic accidence age (year)
≤15 / x,xxx,xxx / xx.xx
16 - 25 / x,xxx,xxx / xx.xx
26 - 35 / x,xxx,xxx / xx.xx
36 - 45 / x,xxx,xxx / xx.xx
46 - 55 / x,xxx,xxx / xx.xx
>56 / x,xxx,xxx / xx.xx
Mean (SD) / xx.x (±x)
Total / x,xxx,xxx / 100%
First response team: gender of road traffic accident patients
Male / x,xxx,xxx / xx.xx
Female / x,xxx,xxx / xx.xx
Total / x,xxx,xxx / 100%
Basic life support team: gender of road traffic accident patients
Male / x,xxx,xxx / xx.xx
Female / x,xxx,xxx / xx.xx
Total / x,xxx,xxx / 100%
First response team: stop bleeding case
Appropriate / x,xxx,xxx / xx.xx
Inappropriate / x,xxx,xxx / xx.xx
Total / x,xxx,xxx / 100%
Basic life support team: stop bleeding case
Appropriate / x,xxx,xxx / xx.xx
Inappropriate / x,xxx,xxx / xx.xx
Total / x,xxx,xxx / 100%
From bivariate analysis data is explore in table 2. First Response’s cases and basic life support (p-value = x.xx) were road traffic accidence case (OR x.xx, 95% CI x.xx to x.xx) and other case (OR x.xx, 95% CI x.xx to x.xx). Basic life support case. Gender of road traffic accident patients (p-value = x.xx) male (OR x.xx, 95% CI x.xx to x.xx) and female (OR x.xx, 95% CI x.xx to x.xx).
For trauma management, airway management case (p-value = x.xx) appropriate (OR x.xx, 95% CI x.xx to x.xx), and inappropriate (OR x.xx, 95% CI x.xx to x.xx). Bone immobilization appropriate (OR x.xx, 95% CI x.xx to x.xx), and inappropriate (OR x.xx, 95% CI x.xx to x.xx). Stop bleeding case appropriate (OR x.xx, 95% CI x.xx to x.xx), and inappropriate (OR x.xx, 95% CI x.xx to x.xx).
Patients aged group xx to xx years constituted the age group which contributed most significantly to the total number of road traffic accident registered more than any other age group (OR x.xx, 95% CI x.xx to x.xx p<0.001).
Table 2 Crude odds ratios of factor…… and their 95% confidence intervals for each factor.
Characteristic / Number (n) / Percent (%) / OR Crude / 95% CI / P-valueFirst Response’s cases from 2010 to 2012 / 0.xxx
Road Traffic Accidence case / x,xxx,xxx / xx.xx / 1
Other case / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
Basic life support’s case from 2011 to 2012 / 0.xxx
Road Traffic Accidence case / x,xxx,xxx / xx.xx / 1
Other case / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
Total
First response team: Road traffic accidence age (year) / 0.xxx
≤15 / x,xxx,xxx / xx.xx / 1
16 - 25 / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
26 - 35 / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
36 - 45 / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
46 - 55 / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
>56 / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
Mean (SD) / xx.x (±x.x) / 100%
Total / xxx,xxx
Basic life support team: Road traffic accidence age (year)
≤15 / x,xxx,xxx / xx.xx / 1
16 - 25 / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
26 - 35 / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
36 - 45 / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
46 - 55 / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
>56 / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
Mean (SD) / xx.x (±x.x) / 100%
Total / xxx,xxx
First response team: gender of road traffic accident patients
Male / 0.xxx
Female / x,xxx,xxx / xx.xx / 1
Total / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
Basic life support team: gender of road traffic accident patients
Male / 0.xxx
Female / x,xxx,xxx / xx.xx / 1
Total / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
First response team: stop bleeding case / 0.xxx
Appropriate / x,xxx,xxx / xx.xx / 1
Inappropriate / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
Total
Basic life support team: stop bleeding case / 0.xxx
Appropriate / x,xxx,xxx / xx.xx / 1
Inappropriate / x,xxx,xxx / xx.xx / x.xx / x.xx – x.xx
Total
Logistic regression explore in table 3. For first response team, stop bleeding inappropriate (OR adjust x.xx, 95% CI x.xx to x.xx). Basic life support, stop bleeding inappropriate (OR adjust x.xx, 95% CI x.xx to x.xx
Table 3. Crude odds ratios and odds ratios adjusted of stop bleeding treatment by first response team and basic life support team and their 95% confidence intervals for each factor
Characteristic / Number (n) / Percent (%) / OR Crude / OR Adjust / 95% CI / P-valueFirst response team : stop bleeding case / 0.xxx
Appropriate / x,xxx,xxx / xx.xx / 1 / 1
Inappropriate / x,xxx,xxx / xx.xx / x.xx / x.xx / x.xx – x.xx
Total / x,xxx,xxx
Basic life support team : stop bleeding case / 0.xxx
Appropriate / x,xxx,xxx / xx.xx / 1 / 1
Inappropriate / x,xxx,xxx / xx.xx / x.xx / x.xx / x.xx – x.xx
Total / x,xxx,xxx
Trauma management of first response team and basic life support team
Characteristic/ inappropriate / Odds ratio / 95%CI / p-valueFirst response team / x.xx / x.xx – x.xx / 0.xxx
Basic life support team / / x.xx / x.xx – x.xx / 0.xxx
Fig. 1. Effectiveness for stop bleeding between first response team and basic life support team, using multiple logistic regression.